Archived: Grimsargh House Care Home

The home was last inspected in March 2015 when we rated the service as requires improvement overall and requires improvement for the key questions of safe and responsive. The other key questions of effective, caring and well led were rated as good. We carried out this inspection to ascertain if improvements had been made to the key questions of safe and responsive and to follow up on the information received by the CQC. The information of concern we received identified potential breaches to a number of the regulations which led us to undertake a full comprehensive inspection of Grimsargh House.

During this inspection we found the home was in breach of 11 of the regulations designed to keep people safe in residential care homes. One of these was a failure to display the last inspection ratings from March 2015.This regulation is in place to ensure people living in the home and those visiting can see how well the home is delivering safe, effective and caring services that meet the needs of people living in the home.

Other concerns were noted around the safe recruitment of staff. We were concerned that there was a lack of available information to show us staff had been recruited that were of suitable character and were suitably trained. There was also a lack of information to show us staff had been supported whilst in their role at the home. This included a lack of formal induction to the role, ongoing training and supervision to ensure they were able to complete their role competently and confidently.

We found the food at the home to be of good quality and freshly prepared. However, when people required more support to ensure they did not become malnourished, we found they did not receive the support they required. This included a lack of referral for specialist support. We found this was also the case when people became a higher risk of falls and other accidents.

We looked at the information the home used to develop people’s care plans and found these were not routinely developed with the person being supported. There was a lack of valid consent acquired from people living in the home, for the care they received. Where people were beginning to develop early signs of dementia the home had not used the guidance within the Mental Capacity Act 2005 (MCA) to ensure these people were effectively supported.

The home had not assessed people’s needs in the event of an emergency including how to safely evacuate people. There was not a contingency plan in place to ensue people could continue to access a service in the event the home became uninhabitable.

Records used to administer medicines safely were poorly kept and omitted key information including how people should take their medicines. Care plans for medicines were not fully developed and no one in receipt of ‘as required’ medicines had a care plan, to inform staff of when these should be administered.

We found the home were not recording or acting on complaints in a responsive manner and there were no recorded complaints for the two years prior to the inspection. We were however aware of two complaints made in the last six weeks and heard one made on the second day of the inspection.

There was not a system of quality audit and the home was not monitoring how the service was being delivered. The policies and procedures at the home were not actively implemented making some audits and monitoring difficult to undertake.

The provider did not actively seek the views of people living in the home. This meant that the manager did not have a clear understanding of whether the service being delivered was what people wanted.

At the time of this inspection there was a registered manager in post who had worked at the home for over 30 years. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Following the concerns noted in this inspection we issued notice to cancel the manager's registration. The manager did not provide representations to the commission for the notice and their registration was therefore cancelled on the 7 July 2016.

Following this inspection we were given assurances by the provider that specific action would be taken to reduce the risks to people living in the home. We were not assured the action had been taken and when we revisited the home on the 11 April 2016 we found additional concerns. The provider was also issued with a notice of proposal to cancel the provider’s registration. The commission received representations from the provider which were not upheld. The provider was therefore issued with a Notice of Decision to cancel their registration on the 6 October 2016.

Due to the concerns raised during this inspection we also issued an urgent Notice of Decision to the provider to ensure they could not accept any new people into the home on the 14 April 2016. The provider made appeals to the first tier tribunal against both the urgent Notice of Decision to restrict admissions and against their Notice of Decision to cancel their registration. Both of these appeals were joined and to be heard at the first tier tribunal.

The provider was inspected again in October 2016 and the report for the inspection is published. We did not find anything during that inspection to assure the commission the provider had taken appropriate steps to meet the requirements of the regulations.

In March 2017 there was an incident at Grimsargh House care home where the management and provider at the home took the steps of evacuating people to a nearby hotel. The commission found the incident which led to the evacuation was avoidable. We also found the evacuation was not managed in line with a suitable emergency evacuation plan. We found the provider had not taken, the action taken in a considered way, to ensure the safety and well-being of the people living in the home. The commission took urgent action to cancel the provider’s registration. At the time of the urgent action everyone living at Grimsargh house was moved to other suitable care homes.

The provider appealed against the urgent action taken and an appeal was heard at the first tier tribunal. The appeal was unsuccessful and as a consequence the provider’s registration is now cancelled and Grimsargh House is no longer a care home at the time of writing this report.

The overall rating for this provider was ‘Inadequate’ from the time of this inspection until its cancellation In February 2018. The home was kept in special measures from the time of this inspection until the registration allowing the regulated activity to be delivered from it was cancelled in February 2018. The commission and the Local Authority worked closely with the home from the time of this inspection until all people living at Grimsargh House were moved on in March 2017.

You can see what action we told the provider to take at the back of the full version of the report.

The registered provider is ‘Button Space Limited’ which is a sole provider of adult social care with the Care Quality Commission.

The home did not have a registered manager in post as the registered manager at the time of the last inspection had left the employment of the provider. The home had a manager in post who had not yet begun the registration process. We discussed this with them and they told us that until their three months probationary period was complete they would not begin the process to register as manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection the service was rated inadequate overall and inadequate for four key questions, these were safe, effective, responsive and well led. Caring was rated as requires improvement. At the last inspection there were 12 breaches to the regulations identified. The regulations breached were; person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse and proper treatment, meeting nutritional and hydration needs, receiving and acting upon complaints, good governance, fit and proper persons employed, notifications of other incidents and the requirement to display ratings of performance assessments.

This resulted in an urgent notice of decision to suspend any new admission to the home on 14 April 2016 immediately following the initial inspection. Further inspections in June and July 2016 were carried out to ascertain if any improvements had been made by the home. A notice of decision to cancel the registered manager’s registration was sent on the 5 July, we did not receive any representations against this decision. A further notice of decision was served to cancel the home’s registration on 6 October 2016 following the lack of progress made by the home in relation to the findings of the inspection in March and April 2016 and the subsequent inspections in June and July 2016.

The home was seen to be displaying the last inspection rating via a copy of the inspection report in the reception area. The home’s website was not displaying the latest rating and was in need of being updated as it stated that the home had vacancies and it contained the name of the previous registered manager for people to contact. The new manager told us that they had not even seen the website as this was not within their remit or part of their immediate priorities. We asked that the website be updated with the current rating on display in line with the CQC's protocols for services that have received a rating under the current inspection methodology.

This inspection took place on the 10 and 11 October 2016 and the first day was unannounced. This means the home did not know we were coming on the day we arrived to inspect. This inspection was carried out at the request of the registered provider as part of an appeals tribunal process that is currently in motion. Previous follow up inspections had been carried out at the request of the appeals tribunal judge in June and July 2016. Formal inspection reports were not produced following these inspections however formal feedback was given to the provider and via the appeals tribunal process.

We saw during the inspection that some improvements to the service had been made. Progress varied across different areas and some areas showed little or no progress. At this inspection we have identified the home have met some of the previous regulation breaches however eight breaches to the regulations were found. The breaches related to safe care and treatment, need for consent, staffing, fit and proper persons employed, receiving and acting on complaints, good governance, requirement to display performance assessments and notification of incidents.

People's medicines were now managed safely. We observed staff administering people’s medicines on both days of the inspection and found them to be knowledgeable and to follow best practice guidelines.

We saw that there were sufficient staff in place to meet the basic care needs of the people living in the home. There had been a number of staff changes since our last ratings inspection, a number of which were seen as positive. The home continued to use agency staff to cover staff vacancies and staff turnover was still high. However we could see that staffing issues were beginning to become more settled and staff we spoke with were happier in their work and told us they had seen a positive change in culture at the home.

We still found the management of falls a concern. This was due to monitoring systems that were previously found to be ineffective still being used, risk assessments not being robust or matching the information in people’s care plans and protection plans from previous safeguarding alerts that had not been routinely implemented. There were also concerns regarding the number of staff having received recent moving and handling training, some of which had been involved in previous issues around falls.

Safeguarding procedures were now clearly on display within the home for staff to follow. We still found that staff knowledge around how to report potential safeguarding issues could be improved.

A number of issues with regard to fire safety within the home were still outstanding, some of which were longstanding issues. There was also a concern that the home had not had a gas safety certificate in place for over 2 ½ years.

We still found issues with how effectively the requirements of the Mental Capacity Act 2005 had been implemented. A number of people who were deemed as having capacity had documentation signed on their behalf and staff knowledge in this area was limited.

Whilst staff told us that support from management had improved greatly there was little in the way of formal support mechanisms in place at the time of our inspection. This included staff induction, supervision and appraisal.

Management of people’s nutritional and hydration needs had improved however we found some people had lost significant amounts of weight so systems need to improve further to manage this area effectively.

We have reported concerns to the appropriate professional bodies regarding the validity of some staff contracts prior to 1 April 2016. We found that whilst recruitment issues had improved there were still concerns regarding the validity of some established staff’s references and other documentation.

Throughout the inspection we observed people being provided with support and interacting with staff. These observations were positive and we noted staff approached people in a kind and respectful manner.

People we spoke with told us they were involved in the planning of their or their loved one’s care and able to make decisions and choices, if they wanted to and were able to. Not everyone was aware of their care plan but those people that were told us they were happy with the level of involvement and influence they had.

We found the home was dealing with complaints outside of its own complaints procedures. We had been made aware of a number of complaints prior to this inspection which were not recorded within the home’s complaints file.

We could see that the home manager had begun to implement systems for quality and safety assurance. However we found that auditing systems had not been fully embedded and some of the actions following audits had not been carried out.

Staff spoke positively about the home manager. They told us that the new manager was supportive, knowledgeable and was beginning to embed a positive culture within the home.

The home manager told us that they were supported in their role but we could find little evidence to show that they received formal supervision or guidance in carrying out their duties.

At the last inspection the home had an overall rating of inadequate and was placed in special measures. After six months we have re-inspected and two key questions remain as inadequate. As a consequence the service remains in special measures.

This service will continue to be kept under review and, if needed we will take further action in line with our enforcement procedures preventing the provider from operating this service. Where necessary, another inspection will be conducted within a further time period, and if there is not enough improvement and there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.